osteopathy

osteopathy first developed from the 1870s onwards in America, under the initial inspiration and guidance of Andrew Taylor Still (1828–1917), who claimed to have discovered a revolutionary new system of healing and an associated therapeutic philosophy. These were based upon two related principal elements; that the healthy body already contained all the relevant capacities for maintaining itself, and that it thus did not need the drug-based remedies of the day. These views at that time were not original, but they were combined with Still's description of ‘osteopathic lesions’. These lesions, unless treated through his system of manual manipulation, were said to disturb the necessary internal balances of the body. Their occurrence became the controversial cornerstone of a distinctive osteopathic pathology. They were thought to be morbid alterations in tissue: muscular, osseous, visceral, ligamentous, or a combination of some or all of those in individual cases. In particular, osteopathic lesions were linked to inadequate articulation of the various parts of the musculo-skeletal system, particularly regarding the condition of the spinal vertebrae. In Still's view, improper articulation produced a disposition to various types of disease, by affecting the neurological system and the circulation of blood and body fluids which were essential to good health.

The social context of the latter decades of nineteenth-century rural America provided a supportive background for Still's beliefs and his related therapeutic evangelism. He was an ‘untrained’ medical practitioner by modern standards, but, as was common in his day, learnt medicine through apprenticeship to his father. He was in practice for many years in Missouri before becoming increasingly interested in bone setting in the 1870s in Kirksville. This was an ancient craft, and the prevailing medical ridicule of it had recently been brought into question. The distinguished London surgeon, Sir James Paget, had published an article, ‘On the Cases that Bone Setters Cure’ in the British Medical Journal. This was followed by Wharton Hood's book On Bone Setting (1871), published in Britain and America. Hood, a general practitioner, was interested in the movements of flexion and extension, combined with external pressure, used by bone setters for back injuries. As Gevitz, a noted historian of osteopathy, points out, at that time Still may have picked up and refined elements of practice which existed in his environment. At this historical point many of the more drastic drug and surgical remedies of conventional doctors did not inspire public confidence, and Still with his ‘new’ methods worked within a tradition of bone setting which was at least familiar to his rural patients. His mechanical theory of health and disease, of aligned and misaligned parts, akin almost to malfunctions of farm machinery, dovetailed nicely with the cultural beliefs of Still's patients.

However, this period was only the starting point of osteopathy's subsequent growth as a rival and different system of practice to medicine in the twentieth century. Still founded a school in 1892 in Kirkville, Missouri, and from this a small group of graduates went on in 1911 to found the British Osteopathy Association. In both countries decades of medical professional opposition to osteopathy followed, but these disagreements had very different outcomes in the two countries, both for medicine and for osteopathy. In the American case, conflict has led eventually to a kind of integration: a movement by practitioners from their initial adherence to Still's beliefs to broadly accepting those of orthodox medicine. Indeed, by the turn of the century the first osteopathic colleges were already teaching some of the medical pharmacopoeia of the day, and gradually pharmacology was brought into osteopathic education and practice. By the 1960s all restrictions on osteopathy as a one-time marginal cult were disappearing, leading to eligibility for medical residencies, and appointment to hospital medical staffs and to positions in the military and public health services. In this gradual process of absorbing and sharing of notions of scientific practice with orthodox medical practitioners, American osteopathic practitioners made manipulation a part rather than the core of their practice.

In Britain and its Commonwealth, professional developments between the two groups have been somewhat different, reflecting in turn their varying social and legal contexts. In Britain osteopaths sought in the 1920s and 30s to secure from the Government the right to practise as independent but different medical practitioners. Eventually this pressure led in 1935 to a Parliamentary Select Committee enquiry into their case, conducted adversarially between two different systems of philosophy and treatment. Eight hundred leading allopathic medical and biological scientists asserted that osteopathy disputed the very basis of modern medical and surgical practice, and that in particular osteopathic lesions could not be affirmed by any objective scientific scrutiny. The osteopaths were not successful in their case for licensing or state registration. Thus they practised under marginalized conditions outside of the National Health Service for forty years after its inception in 1948. By the early 1990s, however, much had changed. Osteopaths had practised successfully for decades as private practitioners; back problems were a major cause of absence from work and were recalcitrant to conventional treatments, and furthermore medical and public attitudes had changed. British osteopaths now presented themselves as complementary practitioners specializing in biomechanics and the manipulation of the musculo-skeletal system. Although extensively trained in basic medical sciences, they did not claim the wider competence of conventionally trained doctors regarding treatment as in earlier decades. In 1993 osteopaths in Britain gained state registration and formal recognition, not so much as an adjusted part of medicine as in America, but as skilled colleagues, akin to physiotherapists, specializing in rather than diminishing the role of manipulation in the treatments they offered.

Gerry Larkin

Bibliography

Gevitz, N. (1982). The D.O.'s: osteopathic medicine in America. John Hopkins University Press, Baltimore.
Wardell, W. (1994). Alternative medicine in the United States. Social Science and Medicine, 38 (8), 1061–8.